Is it ethical to lie to patients when you are doing it in their best interests?

I suspect most of us would answer ‘no.’ Lying to patients deprives them of moral agency, impairs their ability to give informed consent and is shockingly paternalistic. The liar imagines that he or she knows better than the patient herself. The liar may even be correct in this assumption, but lying to patients is unethical nonetheless.

Lactivist dishonesty is deadly not just because lactation professionals lie to patients, but because they lie to each other.

Curiously, both natural childbirth advocates and lactivists, who would be rightly appalled if a doctor lied to them about the risks of childbirth interventions or the benefits of breastfeeding, have no problem lying to women to promote their own ends. Indeed, efforts to promote both natural childbirth and breastfeeding rest on the assumption that telling women the truth will scare women away from doing what is best for them.

Of course activists don’t call it lying. They drape their falsehoods in finery, calling their efforts ‘The Positive Birth Movement’ and ‘Trust Birth’ or the ‘Baby Friendly Hospital Initiative’ and ‘Breast Is Best.’ These sound lovely, but they are lies and paternalism nonetheless.

Consider Milli Hill’s justification for lying to women about the excruciating pain of childbirth.

Most pregnant women are very scared of labour. But by putting all the focus on how painful it is, are we failing to give them the full picture? And in doing so, could we actually be making labour worse – in some sense, setting them up to fail?

Fail? If the baby that’s inside her uterus ends up in her arms alive and healthy, she’s succeeded. When Milli Hill talks about failing at labor she means failing at the conceit of a specific performance of labor — vaginal birth without pain relief or other interventions.

The full picture? What does that even mean in the context of pain? When we tell women that cosmetic surgery involves pain are we depriving them of the ‘full picture’ of face lifts? Or are we giving them what we are ethically required to give them: the truth without which they cannot give informed consent.

The lying and paternalism in lactivism are even worse. Under the guise of promoting what is best for babies, lactation consultants and their organizations aren’t merely lying to women, they are letting babies die. Their motto appears to be ‘Better Dead than Formula Fed.’

Many of the tenets of the Baby Friendly Hospital Initiative are lies. Pacifiers not only don’t interfere with breastfeeding, they prevent SIDS. Judicious formula supplementation not only doesn’t reduce the likelihood of breastfeeding success, it actually increases it. Locking up formula in hospitals doesn’t improve breastfeeding rates, but it does increase the psychological distress of women who can’t or don’t wish to breastfeed.

Lactivist dishonesty is particularly deadly not simply because lactation professionals lie to patients, but because they lie to each other. Lactation consultants are ostensibly medical providers and like all medical providers, they are responsible for preventing, diagnosing and managing medical problems.

There’s an aphorism about diagnosis that has relevance for all providers: ‘what is rare is rare and what is common is common.’

…any approach to problem solving, learning, or discovery that employs a practical method not guaranteed to be optimal or perfect, but sufficient for the immediate goals.

Heuristics are short cuts to diagnoses. Brain tumors are rare; tension headaches are common. When a patient complains of a headache, it’s much more like to be a simple tension headache, not a brain tumor. Sure some people with headaches will have brain tumors, but that represents only a tiny percentage of people with headaches. That’s why most people who have headaches can be reassured and sent away.

In contrast when someone starts coughing up blood, odds are high that something is wrong with their lungs and they should not be simply reassured and dismissed. Doing so can easily result in missing a deadly pneumonia or a deadly lung cancer.

Imagine then if we erroneously taught providers that pneumonia and lung cancer are vanishingly rare and that patients who cough blood from their lungs should be sent home and told to call if they’re still coughing blood a few days later. Many cases of pneumonia and other serious lung ailments would undoubtedly be missed at the moment when they are easiest to treat. Providers would be falsely reassuring patients with deadly conditions because the providers themselves have no idea just how common those conditions are.

That’s precisely what is going on with lactation professionals at this moment. Because they are taught that insufficient breastmilk is rare when in fact it is quite common (affecting up to 15% of women or more), they are falsely reassuring the mothers of critically ill newborns that their babies are fine when, in truth, they are actually dying of jaundice, dehydration, starvation or all three.

Babies are dying because lactivists are lying. And lactivists are lying because they believe that telling women the truth about the risks of breastfeeding as well as the benefits may lead them to ‘fail’ at breastfeeding. But the goal of providers should never be promoting a specific process; that’s unethical. The goal should always be promoting the wellbeing of patients regardless of how that outcome is achieved.

Lying is never justified, whether it is lying about the pain of labor or the risks of breastfeeding.

How about: If you let the baby cry a bit, he won’t be ruined for life? Last night, my husband and I were enjoying a bit of liqueur when my 3-month-old started crying. My husband asked what I wanted to do. “Eh, finish my drink,” I said. By the time I had done so, Baby had gone back to sleep. Given the toothless grin he greeted me with this morning (and the fact that he spends HOURS on my chest), I really don’t think we were guilty of cruelty or neglect, and yet we never would have done such a thing with my first baby. (Granted, she would not have gone back to sleep by herself, period; she was rather high-needs.)

BeatriceC

OT Leo update: It’s been a roller coaster. I’ll think he’s doing better, then he tanks again. Thursday afternoon it took me an hour to get 2mL of formula in him because he kept falling asleep and couldn’t swallow. Last night he actually ate a whole meal’s worth of birdie bread on his own. He hasn’t had formula at all today, and his weight is holding steady, he’s pooping, and he’s not quite as poofed up as he’s been. I’m cautiously optimistic, but he’s seemed like he was recovering before, only to tank again the next day, so I’m trying to to get too excited. Right now he’s eating mostly birdie bread (good) and seeds (junk food) and goldfish crackers (really junk food), but as his vet said, I’m getting calories into him however I can, even if it’s junk food.

Also, I’m having flashbacks to the newborn days. My house is a mess, laundry is staging a coup, dinner is “whatever is easiest” and I have dried formula in my hair. Good times.

Empress of the Iguana People

Leo, stop terrifying your human like this.
Hopefully everything will work out soon. It seems to have been a particularly tough 12 months for you.
At least you aren’t leaking all over. 😉

StephanieJR

Yay Leo!

Cat

I gave up exclusive breastfeeding after three days because I stopped trusting my healthcare providers to tell me the truth if my baby wasn’t getting enough milk. Lack of wet nappies? Oh, don’t worry, you can tell how happy she is. Baby feeds for forty-five minutes then screams for the boob again the moment she comes off, and repeat for seven hours? Just cluster feeding, it’s a good sign. Not sure she’s actually getting anything from the breast? Don’t worry, her stomach’s the size of a marble.

My milk came in after a few days and, you know what, I could probably have stopped supplementing at that point, but I didn’t because I’d lost all confidence that anyone would shout “STOP!” if I was EBFing my baby into a state of dehydration, or worse.

So yes, besides anything else, lying to women is stupid and counterproductive.

StephanieA

Does anyone know why evolution would select for breastmilk to take so long to come in? Is it one of those cases of ‘good enough’ and some babies can tolerate it while others won’t?

Kerlyssa

it’s a huge drain on the mother’s resources. being both pregnant and lactating would be rough in anything but the most abundant food supplied areas.

SporkParade

Part of it is “good enough.” Although it’s also worth noting that humans evolved to live in groups, not in nuclear families, so I expect wet nursing in the first few days of life was common.

yentavegan

I get caught up in trying to second guess evolution too. Evolution ( mother nature) does not guarantee survival to an individual within a species. Our species thrives in group settings and we rely on the group for survival. Human history/mythology has plenty of stories about mothers dying after successfully giving birth…cross nursing/fostering is part of our survival skill set

AnnaPDE

Just because something is the way it is doesn’t mean it was selected for. It’s enough to be not selected against too much, especially when it’s somehow correlated to another beneficial trait. And humans are pretty good at figuring out ways around selective pressure (aka things that kill you): in the case of late lactogenesis, for example, feeding the baby something in the meantime pretty much solves the problem.

Fitst off, nature isn’t perfect. But beyond that, the average baby — and I stress “average” — is neither all that hungry or needs large amounts of nutrition for the first couple of days. Colostrum is rich. Their alimentary tracts are filled with meconium in the intestines and usually considerable mucus in the stomach, and only once they’ve gotten rid of all that gunk do they really get hungry. I think that, had large amounts of milk been needed initially, we probably would have evolved to have gallons available within minutes of delivery. But there are plenty of exceptions and common sense decrees watching the baby to see how he’s coping. My son, for instance, was ready for steak sandwiches by two weeks of age, while my new granddaughter is a very dainty eater.

Merrie

I remember taking an ethics exam in pharmacy school where all the questions essentially boiled down to do you tell the patient the truth about their medications/condition or not and it was just very weird. This was in 2008. Our professor graduated from school himself circa 1960 and I feel like the practice environment that he experienced/learned about must have been wildly different than the current environment. Like… no, I am not going to run into a situation where the doc prescribes something for cancer but doesn’t yet want to tell the patient that she has cancer and instead tells me to tell her it’s for pneumonia. And even if he does, the leaflet will still say what it’s for, or she can Google it. And no doctor is going to tell me to compound anxiety medicine for someone and each week slightly decrease the amount of active ingredient and not tell the patient.

The “is it ethical to lie to someone if it’s in their best interests” question has to encompass the question of what their best interests ARE, and whether the doctor is the person to determine that sans input from the patient.

I did have a tough time over the question of “your old college buddy introduces you to her new fiance and you realize that you recognize him because you used to dispense his HIV meds, do you tell her”.

SporkParade

I’d assume he had told her. HIV+ people still fall in love and get married.

Merrie

I would certainly LIKE to assume that as well. And certainly it’s possible.

fiftyfifty1

OT: Wow, this UK newborn death due to delayed CS is currently the top story at People Magazine on-line here in the US. I can’t believe they sent a woman home at 42 weeks with an abnormal tracing:

That is horrible. How could that not the an emergency and sent to the top of the list? They tried to blame the fact that she was 41 years old and not the way that they handled it. I love how they blame her. She did everything right and trusted them.

fiftyfifty1

I think she is only 38 or 39? Even so, advanced maternal age + 42 weeks + abnormal testing = recipe for disaster.

Kelly

You’re right I must have misread 41 weeks to be her age. Either way, abnormal testing should have put her in the front of the line for getting her c-section. Benjamin would have had a greater chance at life had he gotten it earlier.

Lilly de Lure

It’s disgusting isn’t it – I mean its not like they didn’t have access to any sort of records that could have let them know her age when they were making decisions. It seems like they want it both ways – her age wasn’t enough of a risk factor for them to actually act on it at the time, but it is enough of one for it to get their arses off the line now those lack of actions turned out to be catastrophically misguided.

myrewyn

I had a hard time navigating the article with the tiny pop up video that kept following my mouse around but I got the gist of it and what an awful story. Will a little high profile publicity bring more attention to the dangers of going post dates? I am feeling lucky I had zero trouble scheduling my 39 week induction (now just 5.5 weeks away!) here in the US. My OB said she knew exactly which study I was referencing and within two days the scheduling office had called me to put it on the calendar.

Lilly de Lure

I can – nhs maternity tried the same thing after several abnormal heart traces between 35 and 37 weeks with my son. If I hadn’t followed Dr Amy well enough to know how IUGR, placental failure and distress worked and thus had the tools to resist the fob off he’d be dead as a result. The staff weren’t neglectful or lazy (quite the reverse if anything) they had simply almost brainwashed themselves to avoid seeing clear red flags that would act as indications to a course of action they did not want to take. It’s a reflex – c-sections are BAD therefore anything that might indicate the need for one is suspect. In the case of this tragic couple it looks like they trusted their care providers the way they damn well should have been able to and were let down horrifically.

myrewyn

I wonder how many deaths or near misses this blog has prevented? I’ve been working my way through the archives and it’s something I’ve seen again and again in the comments. I’m glad your son is ok.

An additional problem with many of these lies is that they back-fire in an epic manner.

Take the statement that the LC at the hospital told me – and a shit-ton of other moms around me in the NICU – that you HAD to pump every 2 hours (12x per day) for your milk to come in.

If I believed that statement, I would have stopped pumping for Spawn within a week. I was pumping 6-8x a day and was producing between 5-20mL of milk per pumping at the end of the first week. Based on that, I would have assumed that my milk production failed to start and stopped pumping.

Since I made it a point of honor to ignore the LC’s advice if her ideas conflicted with best practices for cows, I figured that I had some milk production, that I was producing more than enough to feed my 26 week preemie and that as I recovered from HELLP and got more effective at pumping my milk production would ramp up. It did.

I got about 16 weeks of breast-milk production to feed Spawn which got him out of the high-risk time period for NEC and through the rest of his NICU stay. I’ve dropped the number of pumps to 3-4x a day and expect my milk supply to taper-off over the next few weeks. I’ve been insanely busy since Spawn’s came home and I realized quickly that pumping was the easiest thing to drop the list of infant care, medical appointment coordination, wrestling with insurances and taking care of myself. It’s also the only one on the list that was a luxury at this point. Spawn has done fine on fortified breast milk and will do fine on all formula as we shift on to that.

I’m just grateful that I’ve been on this site long enough to not feel any undue sadness over stopping breast-feeding. I realized the sadness I felt when I decided to stop was due to the fact that pumping was the first official “mom” thing I could do for Spawn while he was in the NICU – and I that I felt like I was losing a mom thing.

Knowing that made it easier for me to see the positive side: I could do lots of mom things for Spawn in the NICU and even more things now.

Rocking a gassy Spawn to sleep while singing hymns like my mom did when I was a baby is far more important of a mom thing to do with him right now than having to plop him down so that I can pump – so no regrets.

kilda

I think ignoring any LC advice that conflicts with best practices for cows is an awesome rule of thumb!

Young CC Prof

I really want to see a convention of dairy farmers and a convention of LC’s in the same room.

EbbyBee

I decided to stop pumping when I brought my first twin home from NICU. When I made the decision I felt a wave of relief that I think will always stick with me. I slowly tapered off and was completely done by the time the other twin came home. I’m almost three months out from my last time pumping and I’m incredibly happy. I had one late night obsessive dive into researching relactation but I quickly realized that wasn’t going to be possible with twins, going back to work full time and my mental health.

Christy

I’ve been hit and miss keeping up with this blog. I didn’t realize Spawn was home! That just made my week!!!

The Bofa on the Sofa

And in doing so, could we actually be making labour worse – in some sense, setting them up to fail?

Boy, if that isn’t the pot calling the kettle black.

Setting them up to fail because you tell them that childbirth hurts? As you say, that is a really twisted view of “failure.”

Instead, we tell them that “if you do it right, it doesn’t hurt.” Oh shit, it hurts! Well, you didn’t do it right!

Who is setting who up to fail?

SporkParade

That’s basically what the owner of the hypnobirthing program whose class I took told me. Only she phrased it as inviting me for a cup of tea to discuss ways I could have a better experience next time.

The Bofa on the Sofa

When a patient complains of a headache, it’s much more like to be a simple tension headache, not a brain tumor.

I see maybe one or two people with headaches a day. In 5years since becoming a GP I have yet to see a brain tumour presenting as a headache.

Seen lots of babies who didn’t thrive on breastmilk alone…

The Bofa on the Sofa

How do brain rumors present?

Empress of the Iguana People

hypocondria?

Rachele Willoughby

My sister vomited almost nonstop for three weeks before she got her diagnosis. No headaches though.

MaineJen

Seizures, decreased vision on one side, changes in behavior

Roadstergal

My mom had symptoms that caused her to initially be mis-diagnosed with clinical depression, then she collapsed. No headaches.

Steph858

Interesting philosophical question, to which I do not claim to know the answer: is it REALLY true that lying is NEVER justified when the topic is medical? What about if a doctor decides to prescribe a patient a placebo for very good reasons. One scenario that came to the top of my head was prescribing sugar-pill ‘antibiotics’ to a pestering patient with the flu who would otherwise take up inordinate amounts of the doctor’s time, but I guess the answer to that would be that spending an extra quarter-hour educating the patient regarding the limits of antibiotics’ effectiveness and the dangers of their overuse would save that doctor more time in the long run as hopefully that patient will stop running to the doctor demanding antibiotics every time they contract some minor self-limiting viral infection.

Off the top of my head, the only other scenario I can think of is a doctor working in a situation where medicine is hard to come by – perhaps in a war zone – and real pain relief isn’t available. Would it then be ethical for the doctor to give a placebo and say it’s a painkiller? I’m sure there are other scenarios where it could be argued that it might be ethical for a doctor to prescribe a placebo and for the placebo to ‘work’ the doctor would have to if not outright lie then at least choose their words very carefully.

EmbraceYourInnerCrone

But we aren’t talking about a war zone, and the doctor doesn’t necessarily know what the patient wants or needs. The doctor may not agree with the patient’s decision but it’s really a bad idea to let doctors lie to patients or deliberately not give all the facts or options.

And giving a placebo in the place of antibiotics when the person does not need antibiotics just encourages them to think they need antibiotics for every case of sniffles. It’s also not ethical to charge a patient for medication they aren’t actually getting. Not everyone has prescription coverage and some people(my late mother for one) imagine antibiotics will fix everything and don’t take into account that the cost of them will hit them in the bank account.

Roadstergal

I agree, giving sugar pill ‘antibiotics’ leads to all sorts of negatives down the line, from that particular relationship to the view of antibiotics overall. Telling the truth can be hard, and it can be done with varying degrees of skill, but it’s the only thing that works out long-term.

Sue

I agree – we should develop the benevolent placebo effect of reassurance from an empathetic provider, rather than encourage the need for a “remedy” for every symptom.

Dr Kitty

Which means your provider may get a gastric ulcer providing empathetic reassurance rather than saying “you have the common cold. The only cure for that involves a magic wand, and I seem to have misplaced mine”.

Jen

The answer to that is no, even with a sugar pill, lying is not ethical. This is beyond the fact that all medical providers have an ethical obligation to informed consent. A patient with the flu that has been told they’ve been given antibiotics may well end up with an adverse outcome. They won’t be as likely to self monitor for secondary bacterial infections like pneumonia. Even worse, if the patient presents at the ED with symptoms indicative of a serious infection, it may be overlooked when the patient self reports they are already on an antibiotic. It’s quite common in those cases for the ED to release the patient with the advice to give it 2-3 days since it takes time for the antibiotic to kick in. Many health systems do not have ready access to a patient’s full medical record so a place like the ED would not be aware that the patient’s supposed antibiotic was actually a sugar pill. This is just one example of how a supposed harmless lie could have a very real negative impact. Doctors and medicine aren’t perfect so patients need to have as much information as possible in order to be good self advocates in their own care.

fiftyfifty1

Placebos may be beneficial in some situations, but the good news is you don’t have to lie about them. There are a few studies that show that even when you are totally truthful to patients about something being a placebo, it still often works. Of course placebos have their limits. They only work for subjective symptoms, not objective things. In other words they don’t work for infections or cancer. They also have a mild to modest effect at best. If you break your leg or have a kidney stone, the pain isn’t going to be controlled with a placebo alone.

Steph858

Some food for thought (from the others who replied as well: EmbraceYourInnerCrone, since I live in the UK where we have an NHS and 90% of prescriptions are free, I didn’t even consider the cost aspect, but it’s a very good point). While googling to find the studies you mentioned, I came across a documentary about the placebo effect. In it, a woman suffering from IBS which didn’t respond to conventional treatment enrolled in a study where she was prescribed a sugar pill and TOLD it was just a sugar pill. She didn’t expect it to work at all, but it actually worked miracles for her.

At the end, she laments being unable to access placebo pills now that the study has ended and complains that her IBS is back with a vengeance. I thought “Just go visit a homeopath. That way you get double placebo effect – the standard ‘sugar pill’ placebo effect that you said worked so well the first time, plus the ‘bedside manner’ placebo effect that I’ll grudgingly admit homeopaths are quite good at producing.” Now, I know this would be quite expensive to start with, but cost didn’t seem to be the main barrier to her accessing her sugar pills, and she wouldn’t need to go for the expensive homeopathic consultation every time, she could just buy whichever placebo the homeopath recommended for about £10 a tub after the initial consultation.

So I guess there’s the answer to my question: lying to induce the placebo effect is unethical because the placebo effect can be induced without lying. If necessary, the doctor could say something like “I’m going to give you a pill which contains no active ingredients, but taking it has helped other people in relieving their symptoms.” Not lying, but worded so that the placebo effect might be better maintained?

Sue

One can circumvent the homeoquack and just buy the little “pillules” of lactose and/or sucrose on-line, in bulk.

Altthough, having said that, there is evidence that the effect is stronger if you pay a lot of money for your placebo.

Steph858

I think this documentary was filmed before internet shopping became a thing, but she still could’ve got homeopathic pills from health food shops. That’s why I was surprised when she said she’d been round all the usual suspects asking for a placebo/sugar pill but everyone had told her they don’t have any. I guess the cashier working at a health food shop might be worried she’ll lose her job if she admits, even tacitly, that the homeopathic remedies are just placebos, hence the universal denials regarding the existence of placebo pills.

But she actually asked the people running the study (or at least whoever was her point of contact during the study) if they could supply her with more placebo pills and they couldn’t for some combination of cost and ethical reasons. If I’d been running the study (it wasn’t just this woman who wanted more placebo pills; in an interview later in the documentary the people running it said lots of the participants were begging for more sugar pills when the study ended), I would have told any participant asking for more sugar pills: “I’m afraid I can’t provide you with any because [reasons], but I’m going to let you in on a little secret: homeopathy is an entire system dedicated to providing its patients with placebos. Go to your local health food shop and ask for a homeopathic remedy for IBS; they’ll be happy to sell you a placebo pill specially tailored to treat your ailment.”

The only reason I mentioned a consultation with a homeopath was because I suspected this woman received a lot of care and attention from her point of contact during the study, and this might have been a large part of her miraculous recovery; I didn’t want her to lose the ‘bedside manner’ aspect of the placebo.

Dr Kitty

Our lab seems to come up with low folate levels in a surprising amount of patients.

For the “tired all the time, four children under 10, working full time, unsupportive spouse who is possibly cheating, but no, absolutely, my fatigue has a medical cause and can’t possibly be caused by psychological or social factors” patient folic acid tablets seem to work well.

I say “I don’t think your symptoms are caused by your folic acid levels, but we can always try the tablets to see if they help, because it is just a vitamin and unlikely to cause any harm”.

I’d rather prescribe folic acid to the stressed out, over tired mums in unhappy marriages than antidepressants or sedatives, and these are patients who are not willing or able to consider psychological treatments as an option.

AnnaPDE

The example with antibiotics is a but off imo (antibiotic resistance is a thing, and that person will pester other doctors too), but there’s no need to lie about placebo.
My doctor grandpa had a lot of old ladies who loved him for the Vitamin C and B12 shots. He’d told them that you can really take these things orally and avoid the stinging sensation, but they wanted the shot and who was he to take away someone’s happiness. Also, the opportunity to check on them in a house call was welcome. It worked well in keeping them alive for much longer than expected.

myrewyn

Ha! I know a horse vet who has, in the words of another horse vet, “departed from his training”. He totally does vitamin B12 shots along with his horse acupuncture although not for the same reasons as your grandpa. He’s got a whole following of natural medicine, anti-vaccine horse owners around here.

AnnaPDE

What is it with horse owners and woo? A massive proportion of the horse owners I know are deeply anti-vax, homeopathy loving, naturopath fangirls who will question even the most straightforward medical suggestion by a vet and suspect financial motives, yet happily throw heaps of money and trust at every quack who promises them magic.

Petanque

That’s why I’m a small animal-only vet, I love horses but horse-owners are a whole other Universe!
We’re having terrible difficulties in Australia at the moment with the vaccine against HendraVirus. The virus not easy to transmit but has a high fatality rate. Vets are being pilloried by anti-vacc horse-owners who think the vaccine was developed by Big Pharma to create cancer so we’d all become rich.
No, researchers created a vaccination to prevent both horses and people from a rare but deadly disease you numpties!

Azuran

XD As if we needed Big Pharma for that. Horses are already ridiculously frail things that get sick all the time to begin with.

myrewyn

Absolutely true. Their reproductive system is faulty, their digestion incredibly fickle, and they run around on teeny tiny legs and feet with their thousand-plus-pound bodies. And people wonder why I got out of the business.

Empress of the Iguana People

And that qualifies for the wild ones as much as the purebreds! But ah, I love them. Been horse-crazy since infancy (apparently I watched the entire televised portion of the 1978 triple crown. The horses were 2 years older than me.)

The Bofa on the Sofa

…you look at them wrong and they get laminitis…

myrewyn

Or colic… or lame just before a show.

AnnaPDE

Yeah, it’s the vet costs and extra care that makes horses an incalculable time and money sink. Otherwise I’d have one too. 🙂
My pet theory is that their evolution from large dog size to huge wouldn’t have worked out well had it not been for humans actively supporting and selecting for it despite reduced fitness.
Otherwise I can’t explain this mess of total physiological fragility. And their brains haven’t caught up either – their typical behaviour is still that of small/medium sized prey, when they’re actually strong and dexterous enough to kill with a single kick, and are even capable of cooperation as a herd.

Azuran

Modern horses are indeed mostly made up with human selection. They used to be mostly working animals, I expect they were stronger back then (working horses do have very big feet. )
The breeding for race and acrobatics probably ruined them a lot.

AnnaPDE

The workhorses with bigger feet are still horrible in terms of digestive system though. AFAIK there’s a huge component of weight and exercise in combination with hoofcare involved – which is why, say, spindly Arabians and Berbs have been fine for thousands of years with their tiny feet, whereas muscle Quarters have trouble with the same size. But apparently, despite a great deal of adaptability in hoof shape just from external conditions, “natural” just doesn’t work sometimes: According to UQ research, a lot of Australian brumbies just live with chronic laminitis. :-S

AnnaPDE

*facepalm* I live in Brisbane and every time I see the bats flying over all those horse-affine suburbs around Hendra it’s so nice to remember that researchers actually managed to make a vaccine in such a short time. And then the owners don’t want it? Aaargh.

Who?

I know right. Every time the bats come into my neighbour’s mango tree to eat the mangoes I think of it. We’re about half way between the horse-mad western suburbs and the racecourse.

Personally though lyssavirus is the one that freaks me out, particularly when the occasionally bat is grounded, obviously ill. We’ve had to call the bat lady a couple of times to pick up ill or injured bats.

AnnaPDE

Yes, they’re so cute, and endangered too, so it’s nice to see a large and happy population, at least with no horses around (Indooroopilly, so not quite west enough to be a problem). At the same time I wish they could stop roosting and crapping all over the playgrounds and bike paths here; they seem to specifically pick the trees overhanging those things.

Who?

Hey neighbour, St Lucia here.

There is plenty of wildlife-rainbow lorikeets have just this week deserted my umbrella trees, finally. Pretty but oh so noisy.

myrewyn

It’s hard for me to gauge because I live in what I’ve seen referred to here as “the center of the wooniverse” (Oregon). I can say, however, that my handful of friends who are vets are not well off but this guy flies all over the country to follow the horse show circuits where owners are happy to pay for his treatments and buy his supplements.

BeatriceC

Try parrot owners. OMG these people are insane. It’s all organic all the time because they just don’t understand what organic actually means. And then since there really isn’t much known about avian medicine, the woo can get out of control. I can’t tell you how many times I’ve been told to give Charlotte chamomile tea instead of water in her water dish to “fix” her plucking. No thanks. I think I’ll keep her on her vet prescribed Xanax and Haldol, since those have actually been studied in birds and I know they’re safe.

StephanieJR

Huh. Funny, but most of the other rabbit owned humans I know are very far from the woo; maybe it’s just the forum I frequent, but as soon as a health problem crops up, the usual response is ‘get thee to the vet’. Most of them seem a sensible bunch. Half the fun of having a bun is dispelling myths about rabbits, though, so maybe there’s something in our heads that just makes us more likely to think about vet care over trusting the woo?

StephanieJR

I pretty sure I saw the latter scenario on MASH.

Steph858

I’m working my way through all the episodes of MASH ATM, so will come across that sooner or later. Don’t spoil it for me please!

Charybdis

It’s a Colonel Potter/Charles Winchester episode where the MASH’s morphine was stolen or they couldn’t get any via requisition (I forget which). I won’t spoil it for you, but the Colonel Potter/Charles Winchester reference is for timeline purposes only.

Allie

Remember Stephen King’s “It”? The boy with the hypochondriac mom insisting he has asthma. The town doctor and/or pharmacist gave him a fake inhaler to keep the mom happy. The lie was not to the patient, per se, but to the patient’s mother, and it was arguably in the boy’s best interests (it was definitely in his best interests not to give him unnecessary medication just because the mom was insisting).

SporkParade

I don’t think it’s fair to accuse all lactivists of lying. Some of them just refuse to provide information. Like the hospital nurses my first go around, whose responses to my questions about how to supplement while establishing breastfeeding included such gems as, “If you want to breastfeed, you need to breastfeed,” and, “My job is to tell you to breastfeed.”

EmbraceYourInnerCrone

It’s lying by omission. Omitting the fact that if you don’t supplement, especially after a certain period of time, you risk causing permanent damage to your baby through starvation and dehydration. A nurse should know better. The health and safety of both the patients is what is most important and THAT is a nurses job. NOT making sure everyone breastfeeds.

Roadstergal

Lying by omission, and also by implication – implying that supplementing interferes with breastfeeding as a goal, which the evidence says is not usually the case.

EmbraceYourInnerCrone

Even if it is the case, NOT starving the baby should be a more important goal.

Not eating, for hours and hours or days makes me shaky, nauseous, and eventually angry and frantic. Then finally lethargic, why in the name of the Flying Spaghetti monster would I want to put an infant through that to “preserve the virgin gut” or ” the magical breastfeeding relationship” I wouldn’t want to be starved for days, why would I want to do that to a baby?

EmbraceYourInnerCrone

I sort of tried to breast feed and got no milk and a SCREAMING baby. Would have been nice if the nurses or anyone had mentioned sometimes(often?) your milk doesn’t come in for DAYS. I gave the kid bottles and never looked back.( I was already on the fence about it anyway) my milk came in and HOW about 4 or 5 days later. Was I supposed to just not feed the kid for 4 days…

myrewyn

I was googling something else the other day and stumbled upon a bunch of old paintings of women holding their infants up to goats to nurse so apparently the knowledge that newborns can and often should be supplemented until your milk comes in has been somehow lost.

Valerie

“My job is to tell you to breastfeed.”
It sounds to me like something somebody might say if they had been reprimanded in the past for saying the wrong thing. She could mean “I’m not allowed to do anything to encourage supplementing unless it’s been ordered by a doctor.” If that’s the case, I can’t really blame somebody for following protocol when her job is on the line.

EmbraceYourInnerCrone

If following protocol means not feeding a patient I’m not sure I agree. In what other circumstances would it be OK not to feed a patient and for the patient to lose 10 , 12 , 15% or more of their body weight and the response be JUST PUMP MORE. When the patient is getting NO calories. My reaction would be Give my baby a Damn Bottle or I will sue you, the LC,and the hospital.

SporkParade

The sad thing is, this is the nurse who was telling me to supplement after my baby had already lost a substantial amount of weight. But she felt she had to tell me in a way that required me to read between the lines.

NoLongerCrunching

I am a hospital LC and I do blame people for following “baby friendly” protocol when their clinical skills are telling them that they need to recommend supplementation. Healthcare providers have an ethical responsibility to do what is best for the patient, not what is best for their personal financial needs.

If I lost my job, and my family had to eat ramen noodles and give up cable for a while, at least I could still look them in the eye and know that I was setting a good moral example for them.

Ironically, sometimes the best thing for breastfeeding is to bottlefeed a little to make sure baby as enough energy to breastfeed effectively.

Valerie

I disagree. Hospitals have policies and protocols for a reason, and if an employee refuses to follow them, they will simply be replaced by somebody who will. How does that help anybody? There are plenty of other things in a hospital that an employee may believe are unethical (birth control and circumcision come to mind), and it wouldn’t be OK for them to obstruct access just because they personally believe it’s not in the best interest of their patients.

Here is my understanding of the situation (I might be wrong)- Parents want to supplement because of “soft” cues that the baby isn’t satisfied. “Baby-Friendly” doctrine is that most of these mothers are wrong (suffering from “perceived insufficient milk”), and they just need to be informed that everything is fine. If they do supplement, the breastfeeding relationship will be irreparably harmed and the baby will lose the coveted gold-star, exclusively breastfed status. Thus, it’s the nurse’s job to tell the parents to wait until an evaluation by a LC or pediatrician to determine if supplementation is necessary. If the system is working correctly, nobody is harmed and “optimal” breastfeeding rates are achieved.

Don’t get me wrong- I think any policy that involves delaying supplementation until the parents get a stern talking-to is terrible, and I believe that the research indicates that supplementation is not harmful to breastfeeding. But in any case, I don’t think a nurse has an ethical obligation to bypass the process and assist with non-recommended supplementation.

Allie

Thankfully, the nurse who suggested we supplement (and who went and got us formula and a bottle and told us how much to feed) was a bit older and eminently sensible. I got the impression she’d been around the block a few times and wasn’t about to take leave of her senses with any BFHI nonsense. And you are quite right, the little bit of supplementing we did the first week gave LO the energy to keep practicing her latch, and we went on to nurse successfully for almost 23 months (I would have preferred to stop sooner, but she was not a good sleeper and I didn’t know any other way to cope).

Amy Tuteur, MD

They don’t always realize that they are lying but both philosophies, natural childbirth and lactivism, are based on fundamental lies such as if it natural it must be good, if we’re still here it must be nearly perfect, and good outcomes depend much more on psychology than physiology.

MaineJen

That’s obnoxious.

SporkParade

And unethical. Last I checked, “going over risks and benefits at the patient’s request” was part of being a medical professional.

BeatriceC

If you want to have perfect vision, just use your eyes.

Yeah, that works. Sure. Ugh.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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